After Arm Amputation

Maybe you already know that you are going to have an amputation performed. Even if it is stressful to know – you are not alone at this difficult stage of your life. Your medical team will be supporting you and is always open to all your questions and problems.

Before the operation you will be carefully examined in the hospital several times: The diagnostic includes blood tests, a lung X-ray and an examination of cardiovascular functions.

Before the amputation, the responsible physicians will explain to you the operation process. They will also talk to you in detail about the time after the intervention. During these consultation hours, you will have an opportunity to ask about everything you consider important. We recommend you to note what you want to ask the doctors before the talk, so you will not forget anything. Don't be afraid to clarify if you didn't understand something. By the way, the doctors must explain everything to you several times. In contrast to a planned amputation, an urgent operation is often necessary in the event of a serious injury caused by an accident. Understandably, in such cases you will be able to talk to the doctor only after the amputation.

If possible, you should start exercising before the operation which is important for the later rehabilitation. This way you will be able to strengthen your muscles in advance. Such an early training can make the time after the operation much easier for you. Ask your doctor and physiotherapist what exercises are suitable for you.

It is also helpful to discuss with an orthopedic technician before the amputation, which prostheses you should consider after the surgery. This will give you a better idea of what to expect during your rehabilitation period.

An amputation a decisive point in your life that takes a lot of your inner strength. This is why you should accept psychological support if possible. You can discuss everything with the trained psychologist and thus take off the load from your family and friends. From these conversations you can draw strength for the new stage of your life. The sooner you take this support, the better, because managing your mental conflicts and fears you will contribute to a rapid recovery and sooner regain the high quality of life. An amputation, combined with anxiety, can also lead to a depression. This must be avoided.

We can also advise you to talk to people with a similar amputation or disease. Talking to someone who has already had an amputation is encouraging – you will understand that you are not alone. It is good to hear how others cope with a comparable situation and what changes in their lives (even positive ones!) they can share. Often they will tell you some tips, for example, how to deal with a prosthesis.

The term amputation level is used to describe the area where a part of the body will be amputated. The amputation level, among other factors, also determines what prosthesis is appropriate for you.

The level of amputation is chosen by the doctor before the operation and depends on the amputation cause. In the case of planned interventions, the doctor will consult an orthopaedic technician in order to clarify which amputation height is suitable for the subsequent prosthesis supply.

Hand and finger amputation

In the case of a hand amputation, the entire hand is amputated up to the wrist. The amputation of one or more fingers is called finger amputation. All interventions between the finger and hand amputation levels are called partial hand amputation.

Using individual finger and hand prostheses it is possible to restore the hand appearance up to the smallest detail.

Wrist disarticulation

Disarticulation refers to the hand removal at the wrist joint level, thus the patient loses the wrist mobility. However, the prosthetic stem can usually remain limited to the forearm.

A prosthetic hand as well as adapters and connecting elements for the prosthetic stem are required for the prosthesis supply. The stem is a part of a prosthesis that is connected to the stump.

Forearm amputation

In the case of the transradial amputation, i.e. the amputation in the area of the forearm, one distinguishes between long, medium-long, short and ultrashort forearm amputations.

A prosthetic hand as well as adapters and connecting elements for the prosthetic stem are required for the prosthesis supply.

Elbow disarticulation

In case of an elbow disarticulation, the cut is made through the elbow and the forearm is separated. The upper arm is usually completely retained.

A prosthetic hand, an artificial elbow joint as well as adapters and connecting elements for the prosthetic stem are required for prosthesis supply.

Upper arm amputation

In the transhumeral amputation, i.e. the amputation in the upper arm area, the upper arm bone is cut. Specialists distinguish between short, medium and long upper arm amputation levels.

A prosthetic hand, an artificial elbow joint as well as adapters and connecting elements for the prosthetic stem are required for prosthesis supply.

Shoulder disarticulation

In the case of a shoulder disarticulation, the amputation is performed in the area of the shoulder joint.

A prosthetic hand, an elbow joint, a shoulder joint as well as adapters and connecting elements for the prosthetic stem are required for the prosthesis supply.

Shoulder belt amputation

A shoulder belt amputation means that the entire arm and parts of the shoulder will be amputated up to the shoulder belt.

A prosthetic hand, an elbow joint, a shoulder joint as well as adapters and connecting elements for the prosthetic stem are required for the prosthesis supply.

Good to know: each prosthesis can be covered with a so-called prosthetic glove, making it much less noticeable.

For all amputation heights: individual arm prostheses, e.g. made of silicone, can restore the appearance of the amputated limb and, depending on the amount of amputation, also fulfill its passive functions. They have low weight and are easy to handle.

The first therapy measures begin shortly after the amputation. The wound is treated and prepared for the supply with a prosthesis. As soon as the surgical wound is well healed, the actual prosthetic care and rehabilitation begins. In most cases this takes up to half a year.

In the course of the therapy your cooperation becomes more and more important. You will be assisted by your rehabilitation team. If you find out you do not carry out any of the listed measures, please contact your rehabilitation team. Your therapists can assess whether the measures would be appropriate for you.

Edema therapy

At first after the operation, the stump tissue is usually swelled. This swelling (edema) is a normal reaction to the surgical intervention. It usually subsides after a week. Only a loose wound bandage is applied until the sutures are removed. No pressure should be put on the stump at first.

In order to evaluate the decrease of swelling, the stump size should be measured regularly. It is important to ensure that the same measuring points are always used and that the results are documented in dimension sheets. Otherwise the the measures are not comparable and it is not clear whether the swelling decreases.

Proper stump rest

If the stump remains swollen for a long time, it can cause wound healing problems which can delay the time when the prosthesis can be fitted. You should lie correctly in the hospital bed so that the muscles and joints do not retract or become stiff. At first, patients usually take a comfortable and painless position, but judging by experience it is not always the best. Later the stump should lie as stretched as possible. It must not be rested vertically on a permanent basis – e.g. on a pillow – as muscles can retract and the stump may later be more difficult to move.

Mobilization

You should move your stump several times a day. This will prevent the joints from losing their mobility. Early mobilization is important because it activates blood circulation and helps you to equipoise. Let your therapist show you the movement exercises that are suitable for you at each point of rehabilitation. It is especially important to mobilize the shoulder joint as early as possible, otherwise it can become stiff. A combination of proper rest and movement will help you prepare your arm for a prosthesis installation.

Early compression therapy

After the operation, you will have a special dressing on your wound that should be changed regularly. After that the compression therapy begins, e.g. using a compression bandage. Your treating doctor will determine the right time for the therapy. The aim of this therapy is to reduce the stump edema and to prepare the residual limb for later prosthesis supply. The stump compression helps to optimize the fitting of your prosthesis. In addition, the compression stimulates the blood flow in the stump. This relieves pain and makes the scar heal better.

Compression bandage

Thanks to a compression bandage, the pressure can be changed from day to day or even in the course of a day. The pressure should be highest at the end of the stump and fade towards the body. Elastic pull strap are used to wrap this bandage, which is fixed with plaster. Since this method requires some practice and experience, the bandage should either be placed by qualified personnel (Fig. 3) or you should ask the nursing staff to show you the correct wrapping technique. It is important that the bandage does not constrict the stump, there must be no pain.

Silicone liner

Unlike bandages silicone liner is fast and easy to handle. It is available in various sizes. In order to produce full and uniform pressure at the amputation point, it is essential to ensure that no air is trapped at the stump end when tightening the liner! In the beginning you may be sweating much more in the liner. This will stop after a certain wear period. To avoid skin irritation, you can apply some Ottobock Derma Prevent lotion to the skin at the edge of the liner. Cleaning the silicone liner after each wear is also very important. Please refer to the instruction manual of the liner for further information.

As soon as the stump volume stops changing, which means the measured circumferences of the stump no longer reduce, the physicians can start to prepare it for prosthetic supply. Up to this time, the compression should be constantly maintained. Your treatment team will show you or your relatives how you can take care of it yourself.

Training without prosthesis

This preparatory training strengthens the torso musculature including the abdomen and back muscles, the retained arm and the legs. The stump should also be included in the exercises. Soon the muscles and joints near the stump will also start stretching. If you can barely move the joints actively, you can also support them passively with the help of a towel. It is important that your joints retain or regain maximum mobility in all movement directions.

Depending on whether your dominant or non-dominant hand is affected, a more or less intense training of the retained side is needed. You will train fine motor skills, dexterity and strength. You should practice difficult activities such as writing or brushing your teeth in the first place.

Before the prosthesis is fitted it is important to strengthen the stump muscles, the retained arm, the trunk muscles and the legs with such preparatory training. The exercises will not only improve the mobility of your joints, but also the dexterity of the sound side. This allows you to independently manage your daily activities.

After an amputation, it is especially important that you move your upper body a lot. Do not twists your spine too much. As there is no counterweight on one side, the center of the body and thus often the spinal column posture can change. To avoid poor posture and pain, you should do back-strengthening exercises.

During your hospital stay the nursing staff and the doctors were cleaning the wound and changing the bandages, now that you are in the rehabilitation phase you will be caring for your residual limb, the scar, and the sound leg yourself. Because only with a constant intensive care you will be able to comfortably wear your prosthesis.

After the amputation, the skin on the stump can be very sensitive. There are various measures to prevent it. Always use materials that are comfortable for you and start bandaging from the stump end towards the body.

You may also try to take a soft brush or a porcupine ball and then rub or tap with it over the sensitive skin. This increases its resilience. You can also rub down the stump with a hard towel or flannel.

Hygiene of the stump, such as the daily washing with lukewarm water and perfume-free skin-friendly soap is very important. Ottobock care products can make cleaning easier.

In most cases, the amputation wound will heal within the first three to four weeks and form a scar. But even if the scar may look like it is well healed, and only the color of the scar tissue changes slightly, the healing of the entire scar lasts longer. It takes about a year and a half before it heals completely.

You should regularly grease your scar starting right after the operation, as scarring tissue does not produce its own sebum. Perfume-free creams are recommended for this purpose. Such intensive care is important, so that the scar tissue remains soft and elastic and at the same time resilient. This is necessary for the further prosthesis fitting, because through this care you can avoid the pain in the stump during movements in the prosthetic stem.

Firstly, the stump wound must heal well. When after a few weeks the healing process is completed, the actual rehabilitation begins. It usually lasts up to half a year.

Your treatment team will decide when you can start intensive rehabilitation, depending on your recovery progress. During the rehabilitation phase, you are prepared to wear a prosthesis. The aim is to allow you to regain maximum mobility and independence so that you could lead your life normally in the future. However, your active participation is decisive for the success of rehabilitation. Your motivation and high self-confidence make an important contribution.

Modern arm prostheses enable you to precisely control and grasp objects. The "commands" for these movements are received by the prosthesis through the muscles in the residual limb. The prosthesis is controlled myoelectrically, i.e. using muscle tension. For example, if you tense a specific stump muscle, it will cause the opening of the hand.

In order to make the prosthesis as suitable for you as possible, you must first undergo a so-called Myotest. It is used to measure whether you are able to handle a myoelectrically controlled arm prosthesis. This test and the abilities found in the subsequent Myotraining are used to determine the type of prosthesis that is most suitable for you. Only then can the production of the prosthesis begin.

Depending on the type of the prosthesis and the condition of your stump, there are various ways to put on and take off the prosthesis. It is also important whether one or both sides must be supplied with prostheses. Your physician will show you the appropriate method during the prosthesis dealing training.

Before you put on the prosthesis, you can moisten your skin a little in the area near the electrodes. This reduces skin resistance and improves the conductivity between muscles and skin in the stump and the electrodes in the prosthetic. Without moisture it may take some time before a good contact is established and you are able to control the prosthesis optimally.

Your prosthesis must be taken care of and cleaned every day. To remove sweat residue and skin particles, wipe the lining with a damp cloth. Do not forget to clean your prosthetic glove according to the maintenance instructions and check if it has any cracks. If it has any, have the glove replaced. If you wear a liner, please take care of it daily according to the maintenance instructions.

Depending on the structure of your prosthesis, you will need to learn how to open and close the hand, turn it inward and outward, or how to bend and stretch your elbow. You can also switch between different components.

The next step is to practice motion sequences regularly. This will allow you to automatically control these processes so that you have to think less about the prosthesis handling and contract your muscles for a longer time.

You can use cones, various stacking games or a tree with clamps, that can be changed in their vertical or horizontal position. In order to do it you will need to consciously turn and grab with your prosthetic hand.

After these control training and the repeated exercises, you are well prepared for more complex motion sequences. The daily training is tailored for your personal needs. The exercises are selected according to what is important for you in everyday life and at work./p>

You will begin with simple activities, such as folding a towel and then the exercises will be as complicated a complete meal preparation. The training can include dressing and undressing, opening a bottle and pouring in a beverage, or even handling with your work place. Moreover, eating with knives and forks again without any help is a big step back to independence. You will be amazed at how much your prosthesis can do.